STEP 1

PARQ & Exercise Waiver- Women's Fitness Event

Please complete the following form in as much detail as possible. If there are any questions you are unsure of, please get in touch.

First Name *

Last Name *

Date of birth *

Email *

Phone *

Address *

Postal code *

The Date Today Is *

 FEMALE ONLY QUESTION Do you have a regular menstrual cycle?

Yes

No

 FEMALE ONLY QUESTION Have you lost your period in the past 5 years?

Yes

No

 Do you have any history of mental illness? *

Yes

No

Do you have any current/previous injuries or illnesses that affect your participation in exercise? *

Yes

No

 If yes please state below:

 Do you have high blood pressure? *

Yes

No

 Do you have low blood pressure? *

Yes

No

Has your doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise? *

Yes

No

 Do you have Diabetes Mellitus or any other metabolic disease? *

Yes

No

Has your doctor ever said that you have raised cholesterol (serum level above 6.2mmol/L)? *

Yes

No

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor? *

Yes

No

 Have you ever felt pain in your chest when you do physical exercise? *

Yes

No

 Is your doctor currently prescribing you drugs or medication? *

Yes

No

Have you ever suffered from unusual shortness of breath at rest or with mild exertion? Or suffer from asthma? *

Yes

No

Is there any history of Coronary Heart Disease in your family? *

Yes

No

Do you often feel faint, have spells of severe dizziness or have lost consciousness? *

Yes

No

 Are you, or is there any possibility that you might be pregnant? *

Yes

No

Do you know of any other reason why you should not participate in a programme of physical activity? *

Yes

No

If you answered YES to one or more of the questions above please give details in the box below:

By PRINTING YOUR NAME IN THE BOX BELOW you confirm that you have completed this PARQ and questionnaire based on your current health profile on the date stated above and provided all of the information necessary in order to attend the 'Women's Only Fitness Event'. *

Clear

Waiver & Consent Form: I understand that physical exercise can be strenuous and subject to the risk of serious injury, you are urged to obtain a physical examination from a doctor before participating in any exercise activity. You agree that if you engage in any physical exercise/activity or make any changes to your diet are done so entirely at your own risk. This waiver and release of liability includes, without limitation, all injuries or illnesses which may occur as a result of a) your participation in any activity within this event, b)slips caused by any outdoor running at this event c)any advice given within the workshop. In signing this waiver, you accept the taking of any photos or videos during the event and that these can be used for marketing purchases online (social media, website). You acknowledge that you have carefully read this "waiver and release" and fully understand that it is a release of liability. You expressly agree to release and discharge your coach from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring legal action against your coach for personal injury or property damage. To the extent that statute or case law does not prohibit release for negligence, this release is also for negligence on the part of your coach. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. By accepting and ticking this release below, I acknowledge that I understand its content and that this release cannot be modified.

Yes